ketones

My numbers recently have been absolutely rubbish, pretty much double digits all the way

Yesterday I decided it was time to do something about it and increased by BI in the morning from 5u to 6u. Not a major change, but a start.

I wasn't feeling very well, felt very tired and always on the edge of thinking I would throw up, but spent a good part of the morning sleeping. I took this as just being because my numbers were high.

I woke up in time to get ready and go to the doctors to have my annual bloodwork done (hadn't planned to do it today, just opportune given I was off work) where for the first time in years I thought I was going to be sick and pass out - thankfully not!

Once I got home and tested before lunch I saw that my bgs where finally coming down, although not in range, it was progress. Had lunch and a small corrective dose and before I knew it...

...more sleeping! I tested at 17:38 and somehow my bgs had risen to 15.2mmol/L so I had a further 4u - yes more than I'd have on a normal day as that would take me to 3.2mmol/L but I knew it wouldn't make that much of an impact based on my previous corrective doses.

More sleep and I woke at 19:37 realising I should be checking for ketones.
For the first time I've used the ketostixs it came back positive, in colour terms closer to the 4mmol/L than the 1.5mmol/L.

I confess to retesting just before dinner because it's the first time since being hospitalised with DKA I've had a postive ketone result and it was taking my brain a little while to come to terms with that.

So no surprises (I guess) when the ketone result was the same at 1958 but my bgs at 15.3mmol/L were.
Dinner was 33.6g of carbs, so 3u for the dinner and 7u based on 20% normal TDD. Two hours later ketones had pretty much gone but my bg was still 15.6mmol/L which was a surprise again (to me at least).

Because the ketones had gone I took a 3u corrective dose and 1u for 1CPs worth of salted peanuts and by bedtime I was 8.6mmol/L.
I decided not to correct this any further but take my BI as normal.

I woke to 9.4mmol/L, feeling absolutely shattered but at least no ketones present. Had the same breakfast as the previous day and 1u of correction. More sleep. At 10:14 I was back at 13.4mmol/L so another correction and more sleep.

Now it's lunchtime and I'm 9.6mmol/L, having 4CPs for lunch and a 1u correction.

So I guess I've not quite managed to follow the rules exactly, but I'm trying.
The weird bit is that I don't feel ill, just tired and ordinarily I'd put that down to the constant highs, but this is super sleepy tired. The feeling sick of yesterday has gone but my numbers still don't seem to want to play ball.

So, a couple of questions if I may:

1. Is it sensible to have a few carb free meals to see if this is purely a shift in BI? Am I ill and just don't realise it - if that makes sense?

2. I know I could most probably of handling this better, checking for ketones earlier etc, it would be good to hear what people think I should be doing now, any thoughts?

3. Can someone explain the process around ketones, how does taking 7u remove the ketones but doesn't drop the bgs?
I understand ketones can occur from the body breaking down fat to produce energy but the actual process of sorting it all out afterwards is what I'm unsure about. Is the insulin responsible for clearing up ketones or does the body deal with that in other ways and the insulin just allows the body to stop going to fat sources?

Sorry for the ramble and thanks for taking the time to read
David

davidcragg said:


1. Is it sensible to have a few carb free meals to see if this is purely a shift in BI? Am I ill and just don't realise it - if that makes sense?

From everything you have said, it certainly sounds like you are sick. BGLs go sky-high when we are sick. I had pneumonia a couple of year back, and my BGs were constantly high and difficult to control. The DAFNE handbook link to the right of this page will have a section on sick day rules. Follow that as best as you can, but I'd strongly suggest talking to a doctor ASAP too in case you have something serious. I was sick for over a week before the doctor realised that it wasn't viral, but bacterial. A course of antibiotics quickly cleared things up.

2. I know I could most probably of handling this better, checking for ketones earlier etc, it would be good to hear what people think I should be doing now, any thoughts?

Follow the sick day rules and see a doctor is the best advice I can give.

3. Can someone explain the process around ketones, how does taking 7u remove the ketones but doesn't drop the bgs?
I understand ketones can occur from the body breaking down fat to produce energy but the actual process of sorting it all out afterwards is what I'm unsure about. Is the insulin responsible for clearing up ketones or does the body deal with that in other ways and the insulin just allows the body to stop going to fat sources?

I believe that your last statement is correct. When insulin brings the BGLs down, the body stops going to fat sources for energy and therefore stops producing ketones.

When you are sick, your body becomes much more resistant to insulin (similar to a type 2 diabetic), so you need more (sometimes quite a lot more) insulin for the body to bring the BGLs down.

Hope you get well soon.

Warwick.

Sorry for the ramble and thanks for taking the time to read
David

Thanks Warwick.

I went to the GP yesterday to rule out anything too nasty. Seems to be "something" viral, waiting on some blood results but told to get back to them if things get worse. Spent about 4 hours after that worrying that I was going to be admitted to hospital (won't go into details ), but thankfully got through it and managed to have my evening meal and get some sleep

I'm getting more confident at putting in the bigger doses of insulin when ketones are present and it seems to be working.
What I have learned this week is that if it wasn't for the DAFNE course I would certainly have ended up in hospital so this is been a good opportunity to put theory into practice - this is my first time being ill since dx.

thanks again,
David

If you would like 'live' ketone levels you may wish considering another meter.
I use an Abbott Optium Xceed meter for which you are able to be prescribed Ketone test strips in addition to the normal Blood Glucose testing strips.
Urinanalyis test strips are OK but only give you results of what has already happened...not much use when you are wanting early warning of things going awry when ill.
This meter and Ketone test strips give you a much tighter range for Ketone analysis too...down to 0.1 and although I havn't researched the accuracy of these low value results, I gain confidence from them as they seem to reflect how I am feeling at the time of illness.

Regards
Garry

Yes, it's interesting that when I was on the course I looked through the process and didn't think much about it. Just "Ok, I follow this flowchart when I'm unwell".

Now I'm actually following the sick day rules you suddenly realise how crude the Ketostix measurement is. Useable, but crude.
Sick day rules switch at 3mmol/L but the colour chart on the Ketostix goes 1.5mmol/L and then 4mmol/L.

I will certainly ask about the meter when I'm next in clinic as currently I use the bgstar meter which doesn't have that feature.

thanks,
David

Good stuff. Hope you come right soon. Definitely get an Optium Freestyle (Formerly known as Optium Exceed). Even if you have to buy one, it is worth having for these kind of cases. I've got two in case one of them dies.

Cheers,
Warwick.

Most DAFNE HCPs have access to free meters doled out by the manufacturers. Sweetheart your DAFNE team and I'm sure that they will be able to help.
Once you have one and are satisfied with the performance, phone Abbott on 0500467466 and tell them you are interested in an Optium Freestyle meter for use with both BGs and Ketones. They will normally send one out free....and thus you have 2 meters - 1 in use and 1 standby.
Talk to them at the same time asking about download capabilities of the meter and they will likely supply you with a USB download lead and software to suit your meter.
I have always found Abbott Laboratories a very helpful business. They always used to send out batteries for the meter too, when your low battery warning light comes on, but have stopped doing it as they say they are not now allowed by Royal Mail to send out batteries in the post!
Regards
Garry

A meter that measures ketones if far better and more accurate than urine sticks. There are 2 to try. Glucomen lx plus or the abbott freestyle optium.